Setting CME standards in Europe: guiding principles for medical education.

Objective: The requirement for formal Continuing Medical Education (CME) is growing in Europe with a concomitant focus on quality and independence of medical educational programmes, together with a need for measurable effects on patient outcomes. However, during this rapid evolution, it has become clear that there are misunderstandings and confusion amongst CME providers in relation to standard and regulations. To address this challenging situation, the Good CME Practice Group undertook an initiative to establish a set of standard core principles with a view to adoption by European CME providers and other key organisations involved in provision of CME programmes.

Discrimination between chronological and ovarian age in infertile women aged 35 years and older: predicting pregnancy using basal follicle stimulating hormone, age and number of ovulation induction/intra-uterine insemination cycles.

A marked decline in fertility rates has been demonstrated in women > 35 years of age. We have previously demonstrated the importance of basal follicle stimulating hormone (FSH) concentrations plus chronological age to predict pregnancies in women aged >/=40 years undergoing ovulation induction therapy. The purpose of the current study was to extend our previous study and determine the impact of age, basal FSH concentrations and ovulation induction/inter-uterine insemination (IUI) treatment cycles on pregnancy rates in infertile women age >/=35 years.

Spontaneous pregnancies despite failed attempts at ovulation induction in a woman with latrogenic premature ovarian failure.

Background: Women with premature ovarian failure may conceive spontaneously or following different regimens of ovulation induction.

Case: A 29-year-old woman with eight years of hypergonadotropic hypogonadism following chemotherapy and radiotherapy for Hodgkin's disease conceived spontaneously and spontaneously aborted after discontinuation of estrogen replacement. Subsequently she underwent pituitary gonadotrope downregulation and attempted controlled ovarian hyperstimulation without an ovarian response or follicular development.

Short-term endocrine response to gonadotropin-releasing hormone agonist initiated in the early follicular, midluteal, or late luteal phase in normally cycling women.

Objective: To determine short-term pituitary and ovarian hormonal responses to GnRH agonist (GnRH-a) administered during various phases of the menstrual cycle, in the absence of controlled ovarian hyperstimulation (COH), to determine its independent effect on hormonal parameters previously demonstrated to influence assisted reproductive technology cycle outcome.

Design: Prospective, randomized, controlled crossover study of five regularly cycling women. The GnRH-a, leuprolide acetate (LA), was administered 1 mg SC daily for 5 days beginning on cycle day 3 (early follicular); 8 days post-LH surge (midluteal); or 13 days post-LH surge (late-luteal).

The temporal relation between the urine LH surge and sonographic evidence of ovulation: determinants and clinical significance.

Objectives: 1) To define the temporal relation between self-detection of the urine LH surge and sonographic evidence of ovulation, 2) to identify clinical factors that affect this interval, and 3) to determine whether differences in the day of sonographic detection of ovulation could potentially influence pregnancy rates during timed supracervical insemination cycles.

Methods: Two hundred sixty-nine cycles in 145 women treated in an infertility center were analyzed. The subjects were referred for urine LH-timed supracervical insemination and were managed prospectively by protocol, including transvaginal sonographic confirmation of ovulation.

The effects of Vero (green monkey kidney) cell coculture on the motility patterns of cryopreserved human spermatozoa.

Objective: To determine the effects of Vero (a primate, urogenital epithelium-derived cell line) cell monolayer coculture on cryopreserved human sperm function in vitro.

Design: Prospective, controlled investigation in which cryopreserved semen specimens were thawed, processed, and then simultaneously exposed to control media (Dulbecco's modified Eagle's medium with either 10% heat-inactivated fetal bovine serum [FBS] or 10% heat-inactivated pooled human sera [PHS]) or the same media with the addition of confluent Vero cell monolayers. A second series of investigations was also performed to study the effect of Vero cell conditioned media (CM).

Human spermatozoal tail hypo-osmotic swelling test, motility characteristics in hypotonic saline, and survival of spermatozoa after cryopreservation.

Normozoospermic semen samples (n = 82) were examined to investigate whether the degree of sperm tail swelling in hypo-osmotic medium (fructose and sodium citrate; 150 mOsm/l), and motility characteristics after a 15-min exposure to hypotonic saline (sodium chloride; 150 mOsm/l) could predict the cryosurvival rate (% post-thaw motility/% pre-freeze motility x 100%) of spermatozoa after cryopreservation by the liquid nitrogen vapour freezing method using the TEST-glycerol-egg yolk buffer. The CellSoft automated semen analyser was used to analyse sperm motility in pre-freeze and post-thaw semen samples, and after exposure to hypotonic saline. Sperm tail hypo-osmotic swelling and sperm motility in pre-freeze semen showed no significant correlations (P > 0.

The linear everting catheter: a nonhysteroscopic, transvaginal technique for access and microendoscopy of the fallopian tube.

The linear everting catheter is a new technology that allows for nonhysteroscopic, transvaginal access, and microendoscopy of the fallopian tube. Initial results indicate that this approach is safe, successful, and offers a number of unique advantages relative to the available alternatives. Studies are in progress to explore several of the many possible applications of this system in the diagnosis and treatment of infertile patients.

Ovulation induction in women age 40 and older: the importance of basal follicle-stimulating hormone level and chronological age.

Objectives: To determine pregnancy and livebirth rates for women age 40 and older undergoing ovulation induction and to assess the impact of basal follicle-stimulating hormone (FSH) on outcome in these patients.

Design: Prospective, observational.

Setting: Fertility service of university medical center.

High rates of atypical cervical cytology: occurrence and clinical significance.

The current literature suggests that atypical (benign atypia or class II) Papanicolaou smears occur at a frequency of 1.6-5.4% and are associated with a substantial rate of underlying cervical dysplasia.

Falloposcopic classification and treatment of fallopian tube lumen disease.

Objective: To devise a diagnostic classification and scoring system for tubal lumen disease based on falloposcopy and to evaluate it against tuboplasty procedures and pregnancy outcomes.

Design: Prospective study approved by the hospital Institutional Review Board.

Setting: Academic tertiary infertility center.

The predictive value of a single, early human chorionic gonadotropin measurement and the influence of maternal age on pregnancy outcome in an infertile population.

A single early quantitative hCG measurement 16 to 18 days after timed insemination has prognostic value with regard to pregnancy outcome in an asymptomatic, infertile population. Further, there is a statistically significant difference in the predictive value for hCG levels in patients less than or equal to 35 years compared with patients greater than 35 years of age. Interestingly, the same age-dependent phenomenon was observed when analyzing the predictive value of sonographically detected fetal heart motion at 5 weeks post-ovulation.

The incidence of idiopathic preretinal macular gliosis.

A series of 1,000 consecutive routine eye examinations performed on patients over the age of 50 was evaluated with particular reference to the presence of idiopathic preretinal macular gliosis (IPMG). In this group, there were 64 patients with IPMG (6.4%), 13 (20%) of whom had bilateral IPMG.